Caring for Our Children (CFOC)

Chapter 7: Infectious Diseases

7.1 How Infections Spread

After reading the CFOC chapter introduction, see COVID-19 modification below (Also consult  applicable state licensure and public health requirements).

Attendance at a child care facility may expose a child to the risk of acquiring infectious diseases for several reasons. Young children readily exchange secretions and frequently are not able to perform adequate hand hygiene or cough etiquette. In addition, children and adults with potentially infectious diseases are not always excluded from child care. Staff members face challenges in carrying out recommended risk reduction measures including hand hygiene and in maintaining environmental sanitation in child care settings.

There are three primary modes of transmission for spread of microorganisms in child care settings: contact, droplet, and airborne.

Many common infections encountered in the child care setting are transmitted by direct or indirect contact. Direct contact refers to person-to-person spread of an organism through direct physical contact. Indirect contact refers to spread that occurs by means of contact with a contaminated intermediate object (which could include objects such as shared toys), including hands. Contaminated hands are the most common means of transmission of infections in child care settings.

The majority of common viral respiratory and gastrointestinal tract infections and skin infections among young children, including those due to rhinoviruses, respiratory syncytial virus (RSV), rotavirus, noroviruses, hepatitis A virus, and scabies are transmitted by contact. Bacterial and parasitic intestinal tract infections (such as Shiga toxin-producing E. coli (STEC), Shigella, Clostridium difficile, Giardia, and Cryptosporidium) also are transmitted by contact. Cytomegalovirus (CMV) is transmitted by contact with urine and saliva containing CMV.

Transmission via the droplet route occurs when an infected person coughs, sneezes, or talks, generating large droplets. These droplets are propelled a short distance (generally less than three feet) and are deposited on the eyes, nasal mucosa, or mouth of a susceptible host (person). Infections and organisms transmitted by the droplet route include influenza, mumps, pertussis, RSV, and group A streptococcal (GAS) pharyngitis.

Airborne transmission occurs when small droplet nuclei, dust particles, or skin cells containing microorganisms are transmitted to a susceptible host (person) by air currents. Infections that are transmitted by the airborne route may be spread to others who are quite distant in space from the source infection. Varicella (chicken pox), tuberculosis, and measles are examples of infections transmitted by the airborne route.

Bloodborne transmission of infection through blood or blood containing material in child care is rare, but hepatitis B, C, and D, and HIV are viruses that may be transmitted via bloodborne exposures.

For a complete list of the routes of transmission for various infections, caregivers/teachers may refer to the published Healthcare Infection Control Practices Advisory Committee’s 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (also available at or the current edition of the American Academy of Pediatrics’ Red Book: Report of the Committee on Infectious Diseases (Red Book).

An experienced child care health consultant can be very helpful when dealing with issues around infectious diseases.

COVID-19 modification as of January 07, 2022: 

According to Centers for Disease Control and Prevention (CDC), COVID-19 is a respiratory disease caused by SARS-CoV-2, a new coronavirus discovered in 2019 causing the current pandemic. The virus is thought to spread mainly from person to person through respiratory droplets produced when an infected person coughs, sneezes, breathes, talks or sings. Airborne virus particles can remain suspended in the air and breathed in, and travel distances greater than 6 feet.

Some people who are infected may not have symptoms. For people who have symptoms, illness can range from mild to severe. Adults 65 years and older and people of any age with underlying medical conditions are at higher risk for severe illness.

The following risk reduction strategies are recommended to help decrease the spread of the virus:

  • Wash your hands
  • Wearing a well-fitting mask
  • Stay physically distanced and socially connected
  • Increase fresh air
  • Clean and disinfect
  • Stay home when sick
  • Get vaccinated
  • Screening Testing for COVID-19

As of February 18, 2021, the U.S. Department of Agriculture, the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention highlights there is no credible evidence of food or food packaging associated with COVID-19 transmission.

Early childhood programs should follow local and national guidance during the COVID-19 pandemic.
Additional Resources:

Centers for Disease Control and Prevention

American Academy of Pediatrics.

Early Childhood Learning and Knowledge Center (ECLKC). COVID-19 Risk Reduction Strategies: Posters

Occupational Safety and Health Administration (OSHA). Guidance on Preparing Workplaces for COVID-19.